Enrollment and Eligibility Specialist

Overview

About The Role Brighton Health Plan Solutions is seeking an experienced Specialist for our Enrollment and Eligibility/Employer Services Department to work remotely. We are a hybrid unit, a balance of a contact center and processing department. The Enrollment and Eligibility Team’s (EET) mission is to create, audit, process and update the member and eligible dependents’ profile(s) keeping their health, well-being, and continuity of care at the forefront of our day-to-day operations.

We partner and collaborate with key stakeholders (the client, employer partners, Customer Service, IT, Finance, Carriers, Vendors, and more) to do so successfully and timely. The Enrollment and Eligibility Specialist plays a critical role in our Enrollment and Eligibility/Employer Services Department. Our Specialists are responsible for completing the day-to-day functions of the enrollment and eligibility processing, ensuring that participants are appropriately enrolled in the correct health plan, supporting Eligibility Call Centers, as well as managing the daily communication requirements to and from participants.

The E&E Specialists must be very detail orientated in order to ensure that all forms and documents received in house are processed efficiently, and according to procedure, as well as ensuring that all eligibility and enrollment functions are completed in a timely and accurate manner. The E&E Specialists are also responsible for supporting the client, employers, and members via phone and email support.

• Case Management:
  Create, audit, process and update the member and eligible dependents’ profile(s) into the enrollment database & update the database with changes.
• Data Analytics:
  Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes.
• Troubleshoot Enrollment and Eligibility related inquiries from the Clients, Employer Partners, Health Plan Carriers, the COBRA vendor, and Call Center Representatives.
• Works directly with the Finance team to review, process, and resolve inquiries from the employers and premium related issues: including outreach to employers, the client and State officials --as needed.
• Contact Employers regarding delinquencies and late file submissions –when applicable.
• Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of requests from the client, employers, and members.
• Participate in activities designed to improve customer satisfaction and business performance.
• Solve problems that are sometimes out of the ordinary and that may require reliance on conceptual thinking. Maintain broad knowledge of client requirements, procedures and key contacts.
• Support projects and other departments in completing tasks/projects.
• Other duties as required

• Ability to work alternate schedules/hours based on the business’s need. Our client is on the West Coast. As such, the department’s hours are 10am-9pm EST (7am-6pm PST).
• Bachelor’s Degree preferred or High School diploma / GED (or higher) OR 5-7 years of equivalent working experience.
• 2+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties.
• Knowledge of managed care, labor and commercial carrier enrollment and eligibility procedures including hourly based eligibility and waiting periods.
• Knowledge of eligibility files and transaction sets a plus.
• Must be able to process and/or enter sensitive PHI and confidential Financial Information.
• Proficiency in HIPAA, COBRA, FMLA, LOAs, QLE, PTO regulations and other eligibility related transactions preferred.
• Knowledge of Medicare/Medicaid Benefits is a plus
• Knowledge of Salesforce is a plus.
• Moderate proficiency with Windows 365 applications, which includes the ability to learn new and complex computer system applications.
• Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product.
• Ability to use critical thinking to solve complex problems and identify when to escalate.
• Excellent attention to detail, analytical, and good…